What Is an Aortic Intramural Hematoma?

How Is Aortic Intramural Hematoma Classified?

Aortic IMHs are classified into two main types:

• Type A: Affects the aortic arch’s upward portion (the ascending aorta) with or without affecting the downward part (descending aorta).
• Type B: More common than type A, type B aortic IMHs only affect the descending aorta.

Symptoms of Aortic Intramural Hematoma

Aortic IMH symptoms are often very similar to those associated with aortic dissection. These symptoms, which generally occur suddenly and can vary from patient to patient, include:

• Acute chest pain
• Acute abdominal pain
• Acute back pain
• Pain in the arms or legs
• Shortness of breath
• Weakness
• Loss of consciousness
• Rapid, weak pulse
• Heavy sweating
• Pale skin
• Nausea
• Anxiety

What Causes an Aortic Intramural Hematoma?

The cause or causes of intramural aortic hematomas are not completely understood. However, risk factors associated with the condition include:

• Chronic high blood pressure
• Marfan syndrome
• Bicuspid aortic valve
• Traumatic chest injury
• Atherosclerosis (severe hardening of the arteries)
• Inflammation of the arteries (Takayasu’s arteritis)
• Aortic aneurysm
• Aortic coarctation
• Penetrating aortic ulcer
• Turner syndrome
• Pregnancy
• High-intensity weightlifting
• Cocaine use

Diagnosis of Aortic Intramural Hematoma

Early and accurate diagnosis of an intramural aortic hematoma is important to avoid complications. In addition to a physical examination, diagnosis of an intramural aortic hematoma includes one or more of the following imaging tests:

• Computed tomography scan (CT): A CT scan creates cross-sectional images of the body using x-ray imaging technology.
• Magnetic resonance angiography (MRA): A type of magnetic resonance imaging, MRA is specifically designed to look at blood vessels.
• Transesophageal echocardiography: This test involves the use of an ultrasound probe that is inserted through the esophagus to view the aorta using high-frequency sound waves.
• Aortic angiogram: This procedure uses a special dye and x-rays to see how blood flows through the aorta.

In addition, your doctor may order other laboratory tests, such as blood tests, to rule out heart attack and other conditions that may be responsible for your symptoms.

Treatment of Aortic Intramural Hematoma

Because it is a life-threatening condition, an aortic IMH should be treated immediately. Treatment typically involves surgery and/or medication. If the hematoma develops in the area of the aorta that descends into the abdomen, medication alone may be used to treat it. Patients may also have to take medication to stabilize their condition prior to surgery. Medications used in the treatment of aortic IMH include:

• Beta-blockers (Propanol, Metoprolol) and calcium channel blockers (Diltiazem) to control high blood pressure.
• Vasodilators such as Nitroprusside to control blood pressure.
• Analgesics to relieve pain.

Because type B IMHs are associated with fewer complications, surgery is mainly reserved for patients with type A aortic IMHs. Surgical treatment of type A IMHs includes:

• Thoracic endovascular aortic repair (TEVAR): This minimally invasive procedure is done through a small incision in the groin. Aided by X-ray guidance and special tools, the surgeon removes the damaged portion of the aorta and places a metal tube (stent) covered with a transplanted tissue (graft) in its place. The stent allows for proper blood flow through the aorta.
• Open surgical repair: This is the traditional method of repairing the aorta by removing the defective section of the artery and inserting a graft in its place. Open surgical repair requires a larger incision than TEVAR.